ONFI® (clobazam) is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age or older.

Increased efficacy with increased dosage

REDUCTIONS IN MEAN WEEKLY RATE OF DROP SEIZURES (ATONIC, TONIC, OR MYOCLONIC) BY DOSE (N=217, mlTT)1,2

-12.1
-41.2
-49.4
-68.3

Study Design: CONTAIN (ClObazam in PatieNTs with Lennox-GAstaut SyNdrome) was a randomized, double-blind, placebo-controlled study consisting of a 4-week baseline period followed by a 3-week titration period and a 12-week maintenance period (N=238, randomized). Patients age 2 to 54 years with a current or prior diagnosis of LGS were stratified into 2 weight groups (12.5 kg to ≤30 kg or >30 kg), and then randomized to placebo or 1 of 3 target maintenance doses of ONFI. The dosage groups were: placebo (n=59); low-dose (5 mg/10 mg, n=58); medium-dose (10 mg/20 mg, n=62); and high-dose (20 mg/40 mg, n=59). Doses above 5 mg/day were administered in 2 divided doses. The primary endpoint was the percentage reduction in mean weekly rate of drop seizures (atonic, tonic, or myoclonic) from the 4-week baseline period to the 12-week maintenance period.

  • Drop seizures were defined as drop attacks or spells that involved the entire body, trunk, or head, and1:
    • Led to a fall or injury, slumping in a chair, or hitting the head on a surface
    • Could have led to a fall or injury, depending on the position of the patient at the time of the attack or spell
  • Patients in the trial experienced ≥2 drop seizures per week during the 4-week baseline period, while receiving stable doses of 1 to 3 antiepileptic drugs (AEDs) ≥30 days prior to screening1
  • ONFI causes somnolence and sedation. In clinical trials, somnolence or sedation was reported at all effective doses and was dose-related. In general, somnolence and sedation begin within the first month of treatment and may diminish with continued treatment. Monitor patients for somnolence and sedation, particularly with concomitant use of other CNS depressants2
  • Most common AEs (≥10% in any treatment group and ≥5% greater than placebo, respectively) were somnolence or sedation (32% vs. 15%), somnolence (25% vs. 12%), pyrexia (17% vs. 3%), lethargy (15% vs. 5%), aggression (14% vs. 5%), drooling (14% vs. 3%), irritability (11% vs. 5%), ataxia (10% vs. 3%), and constipation (10% vs. 0%)2

Key enrollment criteria1

  • Age: 2 to 60 years
  • LGS onset before 11 years of age
  • Documentation of EEG with slow spike-and-wave (SSW) (<2.5 Hz) at some point in the patient's history

Dose-ranging trial

MEDIAN PERCENTAGE REDUCTION IN WEEKLY RATE OF DROP SEIZURES3

29%
93%

Study Design: This dose-ranging study was a randomized, double-blind comparison study of high- and low-dose ONFI, consisting of a 4-week baseline period followed by a 3-week titration period and a 4-week maintenance period (N=68). Patients age 2 to 26 years with a current or prior diagnosis of LGS were stratified by weight, randomized to either a low§- or high-dose of ONFI, and then entered a 3-week titration period. The primary efficacy measure was the percent reduction in the weekly frequency of drop seizures (atonic, tonic, or myoclonic), also known as drop attacks, from the 4-week baseline period to the 4-week maintenance period.

  • Adverse events experienced by ≥5% of patients in either treatment group included somnolence, lethargy, sedation, salivary hypersecretion, constipation, aggression, hypomania, and insomnia3

§Low-dose of ONFI: target of 0.25 mg/kg/day (with maximum of 10 mg/day) for weight ≤37.6 kg, fixed dose of 10 mg/day for weight >37.6 kg. ||High-dose of ONFI: target of 1.0 mg/kg/day (with maximum of 40 mg/day) for weight ≤37.6 kg, fixed dose of 40 mg/day for weight >37.6 kg.

READ MORE CLINICAL TRIAL RESULTS

Download the CONTAIN Trial abstract to see an overview of results with ONFI.

DOWNLOAD TRIAL RESULTS

EXPLORE DOWNLOADABLE RESOURCES

Get materials, patient handouts, and other helpful information for your practice 

LEARN ABOUT FLEXIBLE
DOSING FORMULATIONS

Two dosing formulations,
including an oral suspension

EXPLORE ONFI SAVINGS & SUPPORT

Cost-savings information, education, and resources to help your patients

IMPORTANT SAFETY INFORMATION

Indications and Usage

ONFI (clobazam) CIV is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age or older.

Important Safety Information

WARNING:  RISKS FROM CONCOMITANT USE WITH OPIOIDS;

ABUSE, MISUSE, AND ADDICTION; and DEPENDENCE AND WITHDRAWAL REACTIONS

See full Prescribing Information for complete boxed warning.

Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.

  • Reserve concomitant prescribing of these drugs for patients for whom alternative treatment options are inadequate.
  • Limit dosages and durations to the minimum required.
  • Follow patients for signs and symptoms of respiratory depression and sedation.

The use of benzodiazepines, including ONFI, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death.

  • Before prescribing ONFI and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction.

Abrupt discontinuation or rapid dosage reduction of ONFI after continued use may precipitate acute withdrawal reactions, which can be life-threatening.

  • To reduce the risk of withdrawal reactions, use a gradual taper to discontinue or reduce the dosage of ONFI.  
IMPORTANT SAFETY INFORMATION

Indications and Usage

ONFI (clobazam) CIV is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age or older.

Important Safety Information

WARNING:  RISKS FROM CONCOMITANT USE WITH OPIOIDS;

ABUSE, MISUSE, AND ADDICTION; and DEPENDENCE AND WITHDRAWAL REACTIONS

See full Prescribing Information for complete boxed warning.

Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.

  • Reserve concomitant prescribing of these drugs for patients for whom alternative treatment options are inadequate.
  • Limit dosages and durations to the minimum required.
  • Follow patients for signs and symptoms of respiratory depression and sedation.

The use of benzodiazepines, including ONFI, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death.

  • Before prescribing ONFI and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction.

Abrupt discontinuation or rapid dosage reduction of ONFI after continued use may precipitate acute withdrawal reactions, which can be life-threatening.

  • To reduce the risk of withdrawal reactions, use a gradual taper to discontinue or reduce the dosage of ONFI.  

Contraindication: Hypersensitivity
ONFI is contraindicated in patients with a history of hypersensitivity to the drug or its ingredients. Hypersensitivity reactions have included serious dermatological reactions.

WARNING: Risks from Concomitant Use with Opioids
Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. If a decision is made to prescribe ONFI concomitantly with opioids, prescribe the lowest effective dosages and minimum durations of concomitant use. Advise both patients and caregivers about the risks of respiratory depression and sedation when ONFI is used with opioids.

WARNING: Abuse, Misuse, and Addiction
Abuse and misuse of benzodiazepines often (but not always) involves the use of doses greater than the maximum recommended dosage and commonly involves concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes, including respiratory depression, overdose, or death.

Use of ONFI, particularly in patients at elevated risk, necessitates counseling about the risks and proper use of ONFI along with monitoring for signs and symptoms of abuse, misuse, and addiction. Prescribe the lowest effective dosage; avoid or minimize concomitant use of Central Nervous System (CNS) depressants and other substances associated with abuse, misuse, and addiction (e.g., opioid analgesics, stimulants); and advise patients on the proper disposal of unused drug. If a substance use disorder is suspected, evaluate the patient and institute (or refer them for) early treatment, as appropriate.

WARNING: Dependence and Withdrawal Reactions
Patients at an increased risk of withdrawal reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages and those who have had longer durations of use.

The continued use of benzodiazepines, including ONFI, may lead to clinically significant physical dependence. Abrupt discontinuation or rapid dosage reduction of ONFI after continued use, or administration of flumazenil (a benzodiazepine antagonist) may precipitate acute withdrawal reactions, which can be life-threatening (e.g., seizures).

In some cases, benzodiazepine users have developed protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months.

Potentiation of Sedation from Concomitant Use with CNS Depressants
ONFI has a CNS depressant effect. Caution patients or their caregivers against simultaneous use with other CNS depressant drugs or alcohol, and that the effects of other CNS depressant drugs or alcohol may be potentiated.

Somnolence or Sedation
ONFI causes somnolence and sedation. In clinical trials, somnolence or sedation was reported at all effective doses and was dose-related. In general, somnolence and sedation begin within the first month of treatment and may diminish with continued treatment. Monitor patients for somnolence and sedation, particularly with concomitant use of other CNS depressants. Caution patients against engaging in hazardous activities that require mental alertness, such as operating dangerous machinery or motor vehicles, until the effect of ONFI is known.

Serious Dermatological Reactions
Serious skin reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), have been reported with ONFI in both children and adults during the post-marketing period. Discontinue ONFI at the first sign of rash, unless the rash is clearly not drug-related.

Suicidal Behavior and Ideation
Antiepileptic drugs (AEDs), including ONFI, increase the risk of suicidal thoughts or behavior in patients. Inform patients, their caregivers, and families of the risk and advise them to monitor and report any emergence or worsening of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts of self-harm. If these symptoms occur, consider whether it may be related to the AED or illness, because epilepsy itself can increase these risks.

Pregnancy, Registry and Nursing Mothers

  • Based on animal data, ONFI may cause fetal harm and should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.
    • Talk to your patients about enrolling in the North American Antiepileptic Drug Pregnancy Registry; encourage them to call 1-888-233-2334 or visit http://www.aedpregnancyregistry.org/.
  • ONFI is excreted in human milk. Because of the potential for serious adverse reactions from ONFI in nursing infants, discontinue nursing or discontinue the drug.

Adverse Reactions
The most commonly observed adverse reactions reported in an LGS randomized, double-blind, placebo-controlled, parallel group clinical trial of patients who received clobazam as adjunctive therapy (≥10% in any treatment group and at least 5% greater than placebo, respectively) were somnolence or sedation (32% vs. 15%), somnolence (25% vs. 12%), pyrexia (17% vs. 3%), lethargy (15% vs. 5%), aggression (14% vs. 5%), drooling (14% vs. 3%), irritability (11% vs. 5%), ataxia (10% vs. 3%), and constipation (10% vs. 0%).

For more information, please see the full Prescribing Information, including Boxed WarningMedication Guide, and Instructions for Use, or visit ONFIHCP.com.

References
  • Ng YT, Conry JA, Drummond R, et al. Randomized, phase III study results of clobazam in Lennox-Gastaut syndrome. Neurology. 2011;77(15):1473-1481.
  • ONFI [package insert]. Deerfield, IL: Lundbeck.
  • Conry JA, Ng YT, Paolicchi JM, et al. Clobazam in the treatment of Lennox-Gastaut syndrome. Epilepsia. 2009;50(5):1158-1166.